Our goal in implementing health policy is to affect change for the common good. In their 2006 article 'What Does Social Justice Require for the Public’s Health? Public Health Ethics and Policy Imperatives,' Lawrence Gostin and Madison Powers reflect that addressing the social determinants of health through “systematic responses among all levels of government” is the social justice imperative of public health. Through policy we are able to change the playing field for everyone, not just a few select groups. Therefore, as students of health policy and professionals working in the area of health policy, it is important that we remain informed about policy options that are available to address social determinants of health.
For those looking to bring about social justice in public health through policy changes, there are many valuable databases that can be used to identify models policies and analyze the effect of those policies on public health outcomes. One such database, the National Cancer Institute’s State Cancer Legislative Database, serves as an important resource for research and analysis of cancer-related health policy. NCI has provided summaries of legislation affecting cancer prevention and control since the early 1980s. Since 1989, NCI has monitored cancer-related state legislation and maintained the State Cancer Legislative Database (SCLD) Program.
The SCLD maintains information about state laws and resolutions addressing:
- access to state-of-the-art cancer treatment
- breast cancer
- cervical cancer
- colorectal cancer
- health disparities
- genetics
- ovarian cancer
- prostate cancer
- skin cancer
- surveillance (cancer registries)
- testicular cancer
- tobacco
- uterine cancer
The SCLD also maintains limited information about state laws addressing general cancer issues, including health-related treatment and access to state-of-the-art treatment, such as clinical trials and off-label drug use.
NCI, with the assistance of The MayaTech Corporation, works to monitor and analyze cancer-related legislation from all 50 states and the District of Columbia. Community health practitioners and those working to influence health policy can use this resource to answer questions such as:
- Which states require insurers to provide reimbursement for screening mammography?
- How many states have enacted laws addressing genetic discrimination by employers, and what is the extent of those provisions?
- Over the past 5 years, which states have enacted legislation affecting tobacco excise tax rates?
- What are the tobacco taxes in each state?
- Are states that require insurance coverage for clinical trials in close proximity to one another?
Given the increasing research connecting nutrition to cancer, SCLD will begin tracking limited physical activity and nutrition policies beginning in spring 2010. Policy topics that will be tracked include school-based nutrition policies such as nutrition education, competitive foods, reimbursable meals, and access to fruits and vegetables. Kerri McGowan Lowrey, JD, MPH, manager of MayaTech’s Center for Health Policy and Legislative Analysis, which supports NCI’s SCLD Program, is pleased to see an expansion of the types of policies monitored in SCLD. “Legislation that has the potential to improve population health by addressing its most basic determinants, such as adequate and nutritious food, is essential to population level disease control and prevention. As states become increasingly invested in addressing the non-medical determinants of health along with determinants related to the health care system, it is important that policy makers and researchers are able to understand and monitor one another’s work.”
The database could be useful for both seasoned researchers who are members of CHPPD and student members. Several graduate students have used SCLD data for theses or dissertations, either alone, or in combination with health behavior data such as the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) or the Youth Risk Behavior Surveillance System (YRBSS). MayaTech also has produced several research briefs using the SCLD database, which can be found on the SCLD Web site.
Kristi Pettibone, PhD, manager of MayaTech’s Center for Community Prevention and Treatment Research (CPTR) sees an increasing need for evaluating health policy and the effects of health policy on health outcomes. “The usual limitation with policy analyses is trying to understand the time delay between when a policy is implemented and when we can expect to see the effects of policy on health outcomes. Because the SLCD database includes information on when a policy was implemented and any changes that have been to the policy since its implementation, is it a useful tool for examining the effects of policy on community health.”
The SCLD database is just one policy data source that is available for public use. Other policy databases that are available for public use include CDC’s Nutrition and Physical Activity Legislative Database and the State Health Policy section of the Kaiser Family Foundation’s Web site. For more information about MayaTech, visit www.mayatech.com.
By Kristianna Pettibone, KPettibone@mayatech.com